Recovery From Schizophrenia: Psychiatry And Political Economy

50 BACKGROUNDover relatively short periods of time, and some had pointed out that risingadmission rates during the Great Depression appeared to correspond to increasingunemployment figures. 135 Brenner’s work went a great deal further, however, andis still the most important study of the topic.Brenner analyzed admissions to New York state mental hospitals from the midnineteenthcentury to the late 1960s, looking for correlations with measures ofeconomic activity and employment. From 1910 the data included admissions topublic and private hospitals; for the earlier period admissions to one state hospitalwere examined. Admission rates regularly increased during economic decline.This relationship was particularly clear for patients with functional psychosis. Forpeople with schizophrenia from childhood up to the age of around 60 years therelationship was strong, and the finding held true for first admissions andreadmissions. The effect of economic change appeared to be more or lessimmediate; the correlation occurred with no lag but was strengthened by theaddition of a (theoretically acceptable) one-year lag.In select groups of patients the relationship between admission rates and theeconomy was found to be reversed. Elderly patients with senile brain disease weremore commonly admitted during the boom, as were female patients with lateonsetinvolutional psychosis. 136Brenner’s work on mental hospital admissions has been subject to close scrutinyand has survived the challenge largely undamaged. Statisticians James Marshall andDonna Funch criticized Brenner for his use of statistical detrending proceduresand for his failure to make allowances for changes in hospital capacity. Theirreplication of Brenner’s work, taking into account these technical points,essentially confirmed the original findings. The state of the economy, they found,was closely tied to the admission of working-age men and women; but for theyoung and the aged, hospital capacity was a better predictor of admission rates. 137Brenner’s principal finding of a link between the recession and mental hospitaladmissions has since been confirmed by a number of other studies. In Ontario,admissions to a provincial psychiatric hospital for the period from 1960 to 1977were found to exceed discharges during economic slumps; during the boom thereverse held true. 138 Readmissions to state inpatient and outpatient mental healthfacilities in Missouri from 1971 to 1979 correlated with the unemploymentrate. 139 Community mental health center outpatient admissions in Denver,Colorado, in the 1970s were also linked to the unemployment rate. 140What could explain these findings? Brenner examines three theories.Firstly, the tolerance for the dependent mentally ill might decrease as familiesencounter greater economic stress. The data do not support this hypothesis, for themost dependent—the young and the aged—tend to be hospitalized in the boomand not the recession. It seems likely, in fact, that increased mobility during theboom and expanding employment opportunities outside of the home forpotential care-givers may be stronger factors leading to rejection of the mentallydisabled.